Browsing by Subject "Patient Protection and Affordable Care Act"
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Item Open Access Bundled Payment and Care of Acute Stroke: What Does it Take to Make it Work?(Stroke, 2015-05) Matchar, David Bruce; Nguyen, Hai V; Tian, YuanItem Open Access Calorie menu labeling on quick-service restaurant menus: an updated systematic review of the literature.(The international journal of behavioral nutrition and physical activity, 2011-01) Swartz, Jonas J; Braxton, Danielle; Viera, Anthony JNutrition labels are one strategy being used to combat the increasing prevalence of overweight and obesity in the United States. The Patient Protection and Affordable Care Act of 2010 mandates that calorie labels be added to menu boards of chain restaurants with 20 or more locations. This systematic review includes seven studies published since the last review on the topic in 2008. Authors searched for peer-reviewed studies using PUBMED and Google Scholar. Included studies used an experimental or quasi-experimental design comparing a calorie-labeled menu with a no-calorie menu and were conducted in laboratories, college cafeterias, and fast food restaurants. Two of the included studies were judged to be of good quality, and five of were judged to be of fair quality. Observational studies conducted in cities after implementation of calorie labeling were imprecise in their measure of the isolated effects of calorie labels. Experimental studies conducted in laboratory settings were difficult to generalize to real world behavior. Only two of the seven studies reported a statistically significant reduction in calories purchased among consumers using calorie-labeled menus. The current evidence suggests that calorie labeling does not have the intended effect of decreasing calorie purchasing or consumption.Item Open Access Discharge against medical advice from hospitalizations for substance use disorders: The potential impact of the Affordable Care Act.(Drug and alcohol dependence, 2019-04) Zhu, He; Wu, Li-TzyOBJECTIVES:To explore whether the Affordable Care Act (ACA) enactment is associated with changes in the proportion of discharge against medical advice (DAMA) among hospitalizations due to substance use disorders (SUDs). METHODS:Data were drawn from the 2012-2015 National Inpatient Samples. The sample comprised hospitalizations with a principal diagnosis of SUD (i.e., SUD-involved hospitalization) for patients aged 18-64 years (unweighted N = 287,629). Interrupted time series analyses were conducted to evaluate the effect of the ACA on monthly proportions of DAMA among SUD-involved hospitalizations. RESULTS:Overall, approximately 11% of SUD-involved hospitalizations were DAMA. DAMA was most frequently found among hospitalizations for primary opioid use disorder (pre-ACA: 16.4%; post-ACA: 17.2%). Despite the increase in the Medicaid coverage after ACA enactment, there was no significant change in the proportion of DAMA before and after ACA periods across various demographic groups and clinical conditions. Time series analyses also indicated no significant trend effect on the proportion of DAMA during the pre- and post-ACA months. CONCLUSIONS:As many as 1 in 10 SUD-involved hospitalizations were considered as DAMA. Concerted efforts are needed to enhance insurance benefits for SUDs and patients' knowledge of SUD treatment benefits in order to increase SUD treatment engagement and completion and to reduce DAMA, especially for substance-using patients with Medicaid or opioid use disorder.Item Open Access The influence of healthcare financing on cardiovascular disease prevention in people living with HIV.(BMC public health, 2020-11) Webel, Allison R; Schexnayder, Julie; Rentrope, C Robin; Bosworth, Hayden B; Hileman, Corrilynn O; Okeke, Nwora Lance; Vedanthan, Rajesh; Longenecker, Chris TBackground
People living with HIV are diagnosed with age-related chronic health conditions, including cardiovascular disease, at higher than expected rates. Medical management of these chronic health conditions frequently occur in HIV specialty clinics by providers trained in general internal medicine, family medicine, or infectious disease. In recent years, changes in the healthcare financing for people living with HIV in the U.S. has been dynamic due to changes in the Affordable Care Act. There is little evidence examining how healthcare financing characteristics shape primary and secondary cardiovascular disease prevention among people living with HIV. Our objective was to examine the perspectives of people living with HIV and their healthcare providers on how healthcare financing influences cardiovascular disease prevention.Methods
As part of the EXTRA-CVD study, we conducted in-depth, semi-structured interviews with 51 people living with HIV and 34 multidisciplinary healthcare providers and at three U.S. HIV clinics in Ohio and North Carolina from October 2018 to March 2019. Thematic analysis using Template Analysis techniques was used to examine healthcare financing barriers and enablers of cardiovascular disease prevention in people living with HIV.Results
Three themes emerged across sites and disciplines (1): healthcare payers substantially shape preventative cardiovascular care in HIV clinics (2); physician compensation tied to relative value units disincentivizes cardiovascular disease prevention efforts by HIV providers; and (3) grant-based services enable tailored cardiovascular disease prevention, but sustainability is limited by sponsor priorities.Conclusions
With HIV now a chronic disease, there is a growing need for HIV-specific cardiovascular disease prevention; however, healthcare financing complicates effective delivery of this preventative care. It is important to understand the effects of evolving payer models on patient and healthcare provider behavior. Additional systematic investigation of these models will help HIV specialty clinics implement cardiovascular disease prevention within a dynamic reimbursement landscape.Trial registration
Clinical Trial Registration Number: NCT03643705 .Item Open Access The pains of government technology: An investigation into the rollout of Healthcare.gov(2015-03-23) Shah, PriyangGovernments regularly rely on technology to implement policy. While technology development itself is normally not a part of legislative directives, it is an indispensable part of how laws play out in citizens’ lives. The integration of technology and policy, however, does not always go smoothly, a reality often borne out in the public media. The implementation of the landmark Patient Protection and Affordable Care Act through its web site Healthcare.gov is, arguably, one of the most important examples of this connection between federal policy, technology, and media. Unfortunately for the administration and its supporters, the website faced myriad issues from long wait-times to server errors that brought the historic legislation to a standstill. The media covered the event closely, employing a variety of viewpoints and methodologies that helped and hurt the administration’s efforts. This project looks into the media coverage surrounding the website four months before and two months after its initial rollout. While it does not explain the cause of difficulties plaguing the website, it does attempt to explain their portrayal. To this end, the project analyzes media coverage from the left and the right in online newspapers and televised broadcasts to understand what factors affected the tone of the media’s coverage. It finds that media ideology and subject matter shaped the tone of the coverage but in unexpected ways. External factors like Congressional hearings and the 2013 government shutdown may also have had an impact on the tone of the coverage. Clearer definitions and further research are needed here.Item Open Access Using electronic health record data for substance use Screening, Brief Intervention, and Referral to Treatment among adults with type 2 diabetes: Design of a National Drug Abuse Treatment Clinical Trials Network study.(Contemp Clin Trials, 2016-01) Wu, Li-Tzy; Brady, Kathleen T; Spratt, Susan E; Dunham, Ashley A; Heidenfelder, Brooke; Batch, Bryan C; Lindblad, Robert; VanVeldhuisen, Paul; Rusincovitch, Shelley A; Killeen, Therese K; Ghitza, Udi EBACKGROUND: The Affordable Care Act encourages healthcare systems to integrate behavioral and medical healthcare, as well as to employ electronic health records (EHRs) for health information exchange and quality improvement. Pragmatic research paradigms that employ EHRs in research are needed to produce clinical evidence in real-world medical settings for informing learning healthcare systems. Adults with comorbid diabetes and substance use disorders (SUDs) tend to use costly inpatient treatments; however, there is a lack of empirical data on implementing behavioral healthcare to reduce health risk in adults with high-risk diabetes. Given the complexity of high-risk patients' medical problems and the cost of conducting randomized trials, a feasibility project is warranted to guide practical study designs. METHODS: We describe the study design, which explores the feasibility of implementing substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) among adults with high-risk type 2 diabetes mellitus (T2DM) within a home-based primary care setting. Our study includes the development of an integrated EHR datamart to identify eligible patients and collect diabetes healthcare data, and the use of a geographic health information system to understand the social context in patients' communities. Analysis will examine recruitment, proportion of patients receiving brief intervention and/or referrals, substance use, SUD treatment use, diabetes outcomes, and retention. DISCUSSION: By capitalizing on an existing T2DM project that uses home-based primary care, our study results will provide timely clinical information to inform the designs and implementation of future SBIRT studies among adults with multiple medical conditions.